Healthcare Provider Details

I. General information

NPI: 1104213776
Provider Name (Legal Business Name): MOBILE MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 W REDONDO BEACH BLVD STE 101
GARDENA CA
90247-3456
US

IV. Provider business mailing address

1251 W REDONDO BEACH BLVD STE 101
GARDENA CA
90247-3456
US

V. Phone/Fax

Practice location:
  • Phone: 310-953-8756
  • Fax: 310-953-8746
Mailing address:
  • Phone: 310-953-8756
  • Fax: 310-953-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA104536
License Number StateCA

VIII. Authorized Official

Name: LI ZIZHUANG
Title or Position: PROVIDER
Credential: MD
Phone: 310-953-8756